CRA (caries risk assessment)

[pacergal]

DH came home from the dentist today with 2 oral rinses (one for morning and one for bedtime) and high fluoride toothpaste, after having a "CRA" and bacterial count done. He was told his "bad" bacterial count was extremely high (this was a swab from his teeth). This must be a new thing?

 

[athena53]

Sounds like a revenue enhancer to me. How often does he have cavities? To me, that's the real "risk assessment".

I use a variety of preventative measures, most suggested by my dentist or a hygienist at one time or another - cleanings 4X/year (I have implants), a prescription toothpaste, a Water Pik, a Sonicare toothbrush and a bite guard I use at night. I had a large number of fillings from childhood (same good dental care and eating habits as siblings, just unlucky, I guess), a bridge and numerous crowns so something was always decaying or cracking. Now I need a filling maybe once every two years. The dentist has never tested the bacteria in my mouth but I'm convinced that the preventative measures are working and would probably turn down that test.

 

[pacergal]

We have a Sonicare, but he does not floss regularly. I was thinking it was for revenue, but he did not get charged. I will wait for the EOB!! He does have a cpap, and two implants.

 

[tfudtuckerpucker]

Same here- many fillings, a couple of crowns. I'm using prescription fluoride toothpaste, but no rinse.

One thing I have found useful, since I have teeth sensitivity, is use of bioglass toothpaste. Since the FDA won't approve Sensodyne with Novamin in the US, you have to buy it from elsewhere. For me, my teeth are less sensitive, if I combine sensodyne with a prescription fluoride toothpaste. I can also feel the smoothness difference when using it, which is kinda cool.

 

[Accidental Retiree]

Same here- many fillings, a couple of crowns. I'm using prescription fluoride toothpaste, but no rinse.

One thing I have found useful, since I have teeth sensitivity, is use of bioglass toothpaste. Since the FDA won't approve Sensodyne with Novamin in the US, you have to buy it from elsewhere. For me, my teeth are less sensitive, if I combine sensodyne with a prescription fluoride toothpaste. I can also feel the smoothness difference when using it, which is kinda cool.

Thank you for this info. I just placed an order.

 

[LARS]

We have a Sonicare, but he does not floss regularly. I was thinking it was for revenue, but he did not get charged. I will wait for the EOB!! He does have a cpap, and two implants.

Flossing should be part of any adult's normal dental hygiene. Period.

 

[euro]

Flossing should be part of any adult's normal dental hygiene. Period.

There have been recent studies that say otherwise and even in dental schools (my DD is an aspiring dentist) flossing isn't preached as intensely as it used to be.
Personally, I believe your diet (purge the sugar!) has much more to do with the health of your teeth than whether or not you floss.

http://www.webmd.com/oral-health/news/20160802/is-all-that-flossing-really-worth-it#1

 

[LARS]

There have been recent studies that say otherwise and even in dental schools (my DD is an aspiring dentist) flossing isn't preached as intensely as it used to be.
Personally, I believe your diet (purge the sugar!) has much more to do with the health of your teeth than whether or not you floss.

http://www.webmd.com/oral-health/news/20160802/is-all-that-flossing-really-worth-it#1

Well you'll have to pardon me, and my never had a cavity in my life teeth, if I respectfully disagree.

But, hey, if you don't want to floss don't let me stand in your way...

 

[HadEnuff]

Old school retired dentist here:
there has been an academically inspired program called CAMBRA... Which stands for "Caries Management by Risk Assessment" (or something like that). Here is a link to one of the many sites that come up if you Google "CAMBRA"...
http://www.dentalcompare.com/Featured-Articles/2040-CAMBRA-The-New-Model-for-Managing-Caries/

IMO, the main motivation of the program was/is to deal with high caries rates, particularly in "underserved" populations, which is the politically correct way of saying "poor kids with bad diets, and parents who fill their glasses with Pepsi, and their plates with crappy, high sugar foods...." or something to that effect.

What we know: if we reduce in between meal sugars, and at least once/day clean all surfaces of all teeth (sorry folks, that means you gotta floss, or use some sort of mechanical device to reach where the brush, even the expensive SONICARE brush won't reach), you won't have much of a problem with caries. Unless you have some other overriding issues such as diabetes, or severely dry mouth, you'll have very few problems. And if you do have such overriding issues, you will fare much better if you take the above mentioned steps.

Another thing we know: Many people just don't take those steps, and in lower socio-economic groups, the percentages of people who don't take those steps is staggering, and the ones who suffer the most are the children. Hence, an effort such as CAMBRA to try to achieve a lower caries rate among those who, for whatever reasons, are suffering the effects of high caries rates.

I studied this, and I found a few problems with it. Among those was that it still required some patient compliance. Well, guess what? If folks are finding the basic stuff I described above too much work to incorporate into their daily lives (really folks? I can brush and floss my teeth in less than 3 minutes), then they are not very likely to follow the directives of CAMBRA.

But, academics need to have something to research, and justify their grants. So there's that.

 

[marko]

There have been recent studies that say otherwise and even in dental schools (my DD is an aspiring dentist) flossing isn't preached as intensely as it used to be.
Personally, I believe your diet (purge the sugar!) has much more to do with the health of your teeth than whether or not you floss.

When I was a kid, my mother told me "never put anything between your teeth, especially flossing!".

I now tell that to my dentist because I only floss once in a while. The dentist says "Do you do everything you mother told you?"

I reply that she is now 87 and still has every tooth in her head and that my last cavity was perhaps 55 years ago.

 

[euro]

poor kids with bad diets, and parents who fill their glasses with Pepsi, and their plates with crappy, high sugar foods...." or something to that effect.

.

My point exactly. Cut the sugar and you'll be fine. Floss or no floss

 

[HadEnuff]

When I was a kid, my mother told me "never put anything between your teeth, especially flossing!".

I now tell that to my dentist because I only floss once in a while. The dentist says "Do you do everything you mother told you?"

I reply that she is now 87 and still has every tooth in her head and that my last cavity was perhaps 55 years ago.

I would tell people this: a small percentage of people will have dental problems no matter what they do. They'll have fewer problems if they do what we tell them, but it just seems they always struggle, no matter what. Also, a small percentage of people will do fine, no matter what they do. They don't floss, brush, never get cleanings, and they do just fine.
Most people fall into the very large middle group. Do what we say, and they are fine, and if they don't do the sensible things, like brush, floss, watch the sugar, they will have problems.

I had a guy once who swore, in his 30s, that he'd be fine because he "chewed dolomite", and he read that chewing dolomite would infuse his teeth and bones with so much calcium that he'd be impervious to tooth decay. I told him that was interesting theory, but I advised him not to put all of his eggs in that basket.
20 years later when he was faced with losing many teeth to decay, it was, somehow, my fault.

 

[HadEnuff]

My point exactly. Cut the sugar and you'll be fine. Floss or no floss

I'd still recommend flossing. Unless you want that roast beef to just fester there until it ferments and dissolves. I'd bet you money that if a dentist scooped up all of the old bits of meat and non-sugary detritus that accumulates where the brush don't reach, and put it on a cracker, you'd be grossed out at the offer of having it for a snack.

Furthermore, if the absence of sugar eliminates the need for flossing, why brush?

 

[euro]

Furthermore, if the absence of sugar eliminates the need for flossing, why brush?

Cosmetic reasons? Coffee stains, etc

Also, as I'm sure you know, even some complex carbohydrates (wheats products for example) are metabolized by saliva into mono/disaccharides, so unless you cut out ALL carbs, some brushing probably helps. That said, I will venture the guess that frequent and thorough rinsing with clean water would probably take care of most of that.

Look, I'm not opposed to your recommendation - if it doesn't help, it almost certainly won't hurt. Everyone has to decide for themselves - I'm just trying to make the point that not everything is necessarily true, just because we have been told so for a long time. Even if the doctors, the govmint, or the dentist says so. I was more responding to LARS' categoric statement

 

[braumeister]

My dentist has a big sign in his waiting room:

You don't have to floss all your teeth.
Just the ones you want to keep.

I imagine that's a pretty standard sign.

I have sizable gaps between some of my teeth, so flossing is really essential for me. But DW has very tight teeth and needs the thinnest floss so she doesn't do it nearly as often as I do. We both get good checkups.

 

[HadEnuff]

Cosmetic reasons? Coffee stains, etc

Also, as I'm sure you know, even some complex carbohydrates (wheats products for example) are metabolized by saliva into mono/disaccharides, so unless you cut out ALL carbs, some brushing probably helps. That said, I will venture the guess that frequent and thorough rinsing with clean water would probably take care of most of that.

Look, I'm not opposed to your recommendation - if it doesn't help, it almost certainly won't hurt. Everyone has to decide for themselves - I'm just trying to make the point that not everything is necessarily true, just because we have been told so for a long time. Even if the doctors, the govmint, or the dentist says so. I was more responding to LARS' categoric statement

it would be more accurate, I suppose, for me to say something like "effective removal of the bacterial biofilm, 360degrees around the tooth surface", as opposed to saying "flossing". Some folks "floss" but do a crappy job, and wonder why "flossing doesn't help". And to be precise, floss is only one tool, and often not the best tool, to clean the surfaces not reached with a bristle.
But make no mistake about it, a tooth brush, and rinsing, for the great majority of the population, will not keep people out of trouble. I treated dental disease for over 40 years, and I can tell you that most of what breaks down, does so "in between the teeth", precisely because most people brush more effectively, and more often, than they floss.

Refined sugars are the devil, dentally speaking. Avoiding them goes a long way toward avoiding dental disease. Also, in your specific case, you may have grown up in a community with fluoridated water. That is almost as huge as sugar. Maybe even more so.

 

[athena53]

Let me throw in a plug for my WaterPik here, which was recommended by one of my dentist's hygienists. I'm always surprised how much it blasts out AFTER I floss.

 

[HadEnuff]

Let me throw in a plug for my WaterPik here, which was recommended by one of my dentist's hygienists. I'm always surprised how much it blasts out AFTER I floss.

Don't be mislead by the big particles you see coming out with your WaterPik. While it's nice to not have big chunks of food fermenting away in between your teeth, the water flow is not likely to disturb the "bacterial biofilm" that adheres to your teeth.
WaterPik is a great adjunct to brushing and flossing (or whatever mechanical device is effective for mechanically removing/disturbing the biofilm layer), it will not effectively replace it.
A great way to use the WaterPik is after brushing and flossing to use it with a bit of Listerine in the water. The theory is to accept the fact that you might not reach everything with the mechanical device, and the water+Listerine may disturb what you leave behind just enough to push over the edge into the realm of "healthy".

Here is a very good explanation of "plaque" https://en.wikipedia.org/wiki/Dental_plaque

 

[pacergal]

Old school retired dentist here:
there has been an academically inspired program called CAMBRA... Which stands for "Caries Management by Risk Assessment" (or something like that). Here is a link to one of the many sites that come up if you Google "CAMBRA"...
CAMBRA: The New Model for Managing Caries | Dentalcompare.com

IMO, the main motivation of the program was/is to deal with high caries rates, particularly in "underserved" populations, which is the politically correct way of saying "poor kids with bad diets, and parents who fill their glasses with Pepsi, and their plates with crappy, high sugar foods...." or something to that effect.

What we know: if we reduce in between meal sugars, and at least once/day clean all surfaces of all teeth (sorry folks, that means you gotta floss, or use some sort of mechanical device to reach where the brush, even the expensive SONICARE brush won't reach), you won't have much of a problem with caries. Unless you have some other overriding issues such as diabetes, or severely dry mouth, you'll have very few problems. And if you do have such overriding issues, you will fare much better if you take the above mentioned steps.

Another thing we know: Many people just don't take those steps, and in lower socio-economic groups, the percentages of people who don't take those steps is staggering, and the ones who suffer the most are the children. Hence, an effort such as CAMBRA to try to achieve a lower caries rate among those who, for whatever reasons, are suffering the effects of high caries rates.

I studied this, and I found a few problems with it. Among those was that it still required some patient compliance. Well, guess what? If folks are finding the basic stuff I described above too much work to incorporate into their daily lives (really folks? I can brush and floss my teeth in less than 3 minutes), then they are not very likely to follow the directives of CAMBRA.

But, academics need to have something to research, and justify their grants. So there's that.

Thank you for the link, interesting background article. I suspect lack of flossing is DH main problem. He is religiously flossing and brushing, at least since that appointment! I have suggested a waterpik, but so far he says no.

 

[HadEnuff]

Sounds like a revenue enhancer to me. How often does he have cavities? To me, that's the real "risk assessment".

I use a variety of preventative measures, most suggested by my dentist or a hygienist at one time or another - cleanings 4X/year (I have implants), a prescription toothpaste, a Water Pik, a Sonicare toothbrush and a bite guard I use at night. I had a large number of fillings from childhood (same good dental care and eating habits as siblings, just unlucky, I guess), a bridge and numerous crowns so something was always decaying or cracking. Now I need a filling maybe once every two years. The dentist has never tested the bacteria in my mouth but I'm convinced that the preventative measures are working and would probably turn down that test.

When I was D School in the mid 1970s, treatment of periodontal disease was largely focused on surgically cutting gums and recontouring bone. If we could measure 5mm under the gum line this was considered an indication for surgery.
In the mid 1980s following a lot of research from NIH, a new approach emerged. It suggested strongly that shortening the intervals between professional cleanings from 6 months to 3 months, and using irrigators (like WaterPik) with antimicrobial agents (like Listerine) added to the water, ALONG WITH flossing, or inter proximal brushes etc etc. was very effective at stemming the tide of the periodontal destruction in MANY, (unfortunately not ALL, so some periodontal surgery is still helpful in some cases).

Unfortunately, some view this accelerated recall schedule as a "revenue source", which of course it is, but that's what dentists are supposed to do. Make their money helping to control dental diseases. It's a conundrum. I couldn't begin to tell you how many people, after learning of the problem, and the reasons for accelerated recalls would say, "Well my insurance only covers every 6 months" and then wonder why their disease was progressing.

I found that accelerating the recall was close to miraculous. Of course, the folks who would submit to it were also the ones most likely to adhere to the other aspects of care, like doing what we asked at home, but not all, and even a lot of less than clean mouths did well thanks to the once every 3 months attention of disturbing the biofilm, by a trained hygienist with lots of funny shaped instruments to access the diseased areas.

Another critical factor though was the frequent monitoring the worst areas, and early referral to a periodontist for evaluation and treatment.